Robert A. Fink, M.D., F.A.C.S.
Today is: 03rd 2013f May
2013
Dr. Fink's Main Page | Curriculum Vitae | Medicolegal | Contact
The Tao of the Internet
by Robert A. Fink, M. D., F.A.C.S.
On April 11, 1995, I found in my Internet mailbox a message, in "fractured"
English, from a young graduate student at Beijing University in China. It was a
message of desperation. It concerned the plight of a fellow graduate student in
chemistry, a 21-year-old woman who lay in the Intensive Care Unit of the
University Hospital of Peking Union Medical College (PUMC). PUMC is a medical
school established by the Rockefeller family in the early part of the twentieth
century, and, as the model for Abraham Flexner's seminal report on medical
education, perhaps, "the most American of non-American medical schools". A
reconstruction of the young woman's case history to that date is as below:
In early December, 1994, the patient complained of abdominal pain, cramping,
and extremity pain. Extensive tests, including autoimmune studies, thyroid
tests, pelvic and abdominal untrasound, skull x-rays, and bone marrow
examination were all normal. It was noted that the patient had some
abnormalities of her nails, but this was not reported further. She was treated
with "traditional Chinese medicine" and was discharged, improved. She
subsequently returned to work (in a chemistry lab); we still do not know what
chemicals she was working with. An "afterthought" was listed in the report, this
a piece of data which was to become critical in the diagnosis of this woman's
condition; and that was the fact that, shortly after the onset of the abdominal
symptoms on December 8, 1994, the patient's scalp hair fell out, and she "became
bald".
After a period of improvement (and some re-growth of hair), the patient
returned to the hospital with signs of peripheral neuropathy in the extremities,
rapidly progressive disturbances in sensorium (and recurrent alopecia),
developed multiple cranial nerve palsies, became comatose, and required a
ventilator. She also showed muscular spasms, described as "oculogyric crises",
and a tracheostomy was performed. Lumbar puncture and MRI studies of the brain
were normal, and studies for viruses, including Lyme Disease, were negative. The
patient was treated with "shotgun" antibiotics with no improvement.
At that point, the author corresponded with the sender of the "distress
message". I learned that a number of other physicians, including people from the
United States, Canada, Great Britain, Singapore, Thailand, Indonesia, and other
countries, were also communicating with the student-sender and several other
students at the University. The students in China have Internet connections but,
(as we later learned), hospitals and physicians do not. We were forced to engage
in our later communication with the medical professionals either by facsimile,
which is tightly controlled by the Chinese Government; or by sometimes
circuitous person-to-person connections. Information transmitted over the
Internet to the students often did not reach the medical professionals who were
treating the patient. This was due to the complex hierarchy of the Chinese
culture, in which accepting information from "students" is almost as alien to
Chinese professionals as is dealing with "outsiders". This lack of direct
communication has proven to be the most significant negative factor in this
equation.
One of the earliest possible diagnoses which came to the mind of the author
(and several others of the "outsiders") was that of heavy metal poisoning (the
alopecia was the "clue"). We asked if tests had been performed for heavy metals
and were assured that such had been done early on. We later discovered that
these consisted only of a screen for arsenic!
By March 16, 1995, the patient had been in coma for several weeks; and,
despite normal cerebrospinal fluid findings, a diagnosis of Guillain-Barre
syndrome was made by the Chinese physicians. By April 12, 1995, the patient's
condition had not changed, and a repeat lumbar puncture revealed an elevated
protein (248 mg.%) and 6 leukocytes. The impression of Guillain-Barre syndrome
was reinforced, despite messages from the "outsiders" that this picture was not
consistent with Guillain-Barre.
At about this same time, the author and John W. Aldis, M.D., a physician
working in the U. S. State Department, and formerly the Embassy physician in
Beijing, conceived of the idea of thallium poisoning, this after Dr. Aldis was
sent an article by Rose Miketta, M. D., a physician with Searle Pharmaceutical
Company, explaining the neurotoxic effects of thallium. We again suggested that
the patient be checked for thallium poisoning. This recommendation was further
backed by others, including Dr. David Bullimore at St. James' Hospital in
England, and several other p hysicians in the United States. Yet, two weeks
passed before the Chinese physicians decided to perform the thallium study. It
required an intervention by personnel at the American Embassy in Beijing, and
personal contacts between Dr. Aldis and several o f the PUMC doctors (whom Dr.
Aldis had known from his days in Beijing), and faxes of articles directly to the
hospital, before the test for thallium was finally run. The results were
striking. The patient had levels of thallium in blood, urine, cerebrosp inal
fluid, hair, and nails which were more than 50 times higher than "normal"! As to
the source of the thallium, this remains unknown; but certain laboratory
chemicals contain thallium; and, in the Orient, there are several industrial
compounds (includi ng several brands of rat poison) which contain thallium (its
use is generally outlawed in the western world).
